Conjunctivitis is an ophthalmologic disorder mainly characterized by inflammation of the conjunctiva. Conjunctivitis is usually caused by viruses, allergy or bacteria, although conjunctival irritation from wind, dust, smoke, and other types of air pollution is also quite frequent. This disorder may also accompany the common cold, exanthems, and corneal irritation due to the intense light of electric arcs, sun lamps, and reflection from snow. In the case of bacterial infections, antibiotic ointments are usually applied. However, if allergy is likely on the basis of history and if there is lack of response to antibiotic therapy, topical corticosteroid therapy can be initiated.
Vernal conjunctivitis is a bilateral chronic conjunctivitis, probably allergic in origin, usually recuring in the spring and lasting through the summer. It is often associated to intense itching, lacrimation, photophobia, conjunctival injection, and a tenacious mucoid discharge containing numerous eozinophiles. Although these symptoms usually disappear during the cold months and become milder over the years, the granulations which appear in the upper lids during spring and summer often persist for life. Again, applications of topical corticosteroids are usually beneficial but must often be supplemented by small oral doses. Furthermore, topical applications of steroids for long periods of time are usually not recommended and intraocular pressure must in these cases be carefully monitored.
Another frequent form of conjunctivitis, keratoconjunctivitis sicca, is characterized by a chronic, bilateral dryness of the conjunctiva and sclera leading to dessication of the ocular surface. This type of conjunctivitis occurs more commonly in adult women. It is initially characterized by reduction of tear production leading to burning and irritation as well as pain in the fornices during the night. This proceeds to photophobia and blepharospasms as the corneal epithelium develops scattered cellular loss which is termed superficial karatitis. In its advanced stages, karatinization of the ocular surface occurs and is frequently associated with loss of the normal configuration of the conjunctival fornices.
Various degrees of follicular conjunctivitis may be observed. Thus, depending on the amount of follicles detected on the conjunctival side of the eyelids tarsus, especially the superior eyelid, various grades of conjunctivitis are diagnosed. In most cases, this type of follicular reaction is due to "hay fever" and contact lenses and there is not adequate efficient local treatment for this affection.
In the latent stage or grade I, 10 to 20 microfollicles may be localized at the angles of the eversed superior tarsus. A smaller amount of microfollicles can also be found on the edge of the inferior eversed tarsus. In the event smaller overall amounts of microfollicles are observed, the condition can be described as a fraction of grade I, such as grade 0.5 or grade 0.25. At this stage, no inflammation is noted and no pain is felt by the patient.
Grade II is characterized by the presence of microfollicles on half of the height of the tarsal plate. Oedema of the tarsal plate may also be present. It is usually characterized by a dull, satin aspect of the tarsus, an absence of lubrication and very often by redness caused by inflammatory hyperhemia.
Finally, grade III corresponds to a stage where most of the tarsal plate is covered by microfollicles, accompanied by oedema and redness. At this stage, the presence of a few follicles as well as redness may be noted on the inferior tarsus. In grade IV, large follicles forming folds as well as oedema, redness and secretions may be seen on both tarsus as well as on the bulbous conjunctiva.
Although some relief medication is currently available, an effective chemical treatment for conjunctivitis is still being sought.
Therefore, effective medication useful in controlling, diminishing or even eliminating the various forms of follicular conjunctivitis as well as ocular dryness would be highly desirable.